The
overall goal of RCH programme is to reduce infant and maternal
morbidity and mortality in the state. These goals will be achieved
through improvement in quality, enhancing accessibility and availability,
and coverage with the reproductive and child health services,
including family welfare. The programme emphasizes empowerment
of women and communities for enhancing health service utilization
to achieve reproductive goals and population stabilization.

OUTCOMES

Goal of Rajasthan upto 2011-12

Infant Mortality
Rate (IMR

)

32

Maternal
Mortality Ratio (MMR)

148

Total Fertility Rate (TFR)

2.1

Crude
Birth Rate (CBR)

21

Crude
Death Rate (CDR)

7

Key
Strategies

There
are twelve key strategies identify for RCH II

1.
Strengthening Project Management Structure at state and district
levels

Re-organizing of Medical Directorate.

Renovation of Medical Directorate and NRHM/RCH-II cell .

Setting up, of the PMU at state & district levels .

Induction of newly appointed professionals done on programme
management and interventions.

Support for communication , equipments and mobility to DPMUs.

2.
Strengthening Infrastructure at various levels of health service
delivery

Upgrading of PHCs as BemOCs.

Provision of blood storage at 26 identified CEmOCs of IPD districts
to make them fully functional.

Support for equipment and labor tables at 25% PHCs.(10000.00
Rs. Per Institution)

Support for minor repair and renovation of public facilities
at 50% PHCs. .(25000.00 Rs. Per Institution)

Facility
survey of all PHC and CHCs.

3.
Human resource development and capacity building

Development of annual training calender.

Strengthening of ANMTCs.

Support medical colleges for Anaesthesia trainings.

Library at SIHFW & Medical Directorate.

Orientation of AYUSH Doctors on National Programmes.

4.
Improving quality of care and Strengthening Referral System

Study on referral system by RHSDP

7 days Mobility support to PHC MOs

Installation of new telephone connection at all PHC/CHCs.

Work shops for developing standards and protocols for quality
of care.

5.
Strengthening and improvement of logistics and supply systems

Feasibility study to setting up of the drugs and logistics
warehousing has been done under European Commission SIP programme.
A committee to finalize the modalities behind the setting
up of Drug Corporation has been set up at the state level.

Support for the repair of workshop for cold chain equipment
has been provided for Jaipur.

Support for hiring 12 new refrigerator mechanics has been
provided to district where such positions are vacant.

Collaboration with IMA & FOGSI to build partnership to
improve assess and quality of health care service in services.

Accreditation of Private nursing home for JSY.

MNGO scheme in all districts.

Annual consultation with stakeholders on NRHM.

Social marketing of contraceptives and other health services.

10.
Innovative schemes and pilot projects

Pilot Project on Population stabilization initiated at Jhalawar
& Tonk.

PARINCHE project for five districts.

A help line proposed at medical directorate for improving
communication between field level functionaries, districts
and state level officers.

Campaign on Age at Marriage.

Medical Mobile unit for all districts.

VCTC at 16 CHCs.

11. Improving and strengthening RCH Services in Tribal population

Six districts, namely, Baran, Banswara, Chittorgarh Dungarpur,
Sirohi and Udaipur will be included as non-primitive tribal
group districts under the project in addition to the tribal
population in the adjoining blocks of Jhalawar and Kota district.

Process for developing PIP for six urban district is under process.

12.
Establishing and strengthening RCH services in Urban Area

The programme will address the urban slum population in Jaipur,
Jodhpur, Kota, Bikaner, Pali, Udaipur, Ganganagar, Hanumangarh,
Bhilwara and Tonk cities.
PIP for 8 urban slums is under process.

Immunization

Complete
immunization of a child is an important step towards the good
health status of the child, hence Immunization has been kept as
a major strategy. The complete Immunization in Rajasthan is poor
as reported from independent surveys.

Comparison
of Reported and Evaluated Coverage 2005-06 (%)

Antigen

Reported Coverage 2005-06

NFHS-III 2005-06

RCES
2006

Reported Coverage
2006-07

Fully Vaccinated

92.16

26.50

48.30

88.89

BCG

102.09

68.50

84.50

98.90

DPT3

100.06

38.70

61.40

95.52

Measles

96.85

42.70

51.60

93.53

Drop-out BCG-Measles

5.13

NA

NA

5.45

TT2+ Booster

88.71

NA

NA

91.30

Summary
of Recent Initiatives

1. Service
delivery improvements
To enhance Immunization Coverage, MCHN Days are organised as
an essential component of Routine Immunization. It is a package
of service delivered to the community which involves Maternal,
Child and Nutritional components. Mobility support is being
provided by different agencies to all the districts for vaccine
and logistics supply to the session site. This will be smoothened
after coming of RCH 2 budget in which the state has asked the
budget for mobility support as alternative vaccine delivery.

2.Financial Support for Social Mobilizers

3.
Partnerships with other agencies / organizations (e.g. ICDS, IAP,
PP etc.)
In immunization activities, lot of support is being provided by
different agencies like ICDS, UNICEF, WHO, CARE etc. These agencies
are providing the technical & managerial support in different
immunization components. Financial support is being provided by
UNICEF in certain areas. A good coordination of the health department
with Women and Child department through ICDS is well established.
WCD Director is Co-Chairperson in State immunization Steering
committee. State is planning to involve NGOs working at district
level to support in improving the social mobilization which is
a need of the programme. State also needs support from IAP, IMA
and other Private Practitioners to be actively involved in immunization
programme.

Bottlenecks
for full Coverage

State needs a State
vaccine depot at Jodhpur, which can supply vaccine to Jodhpur
region. At present the Jodhpur region is procuring vaccines
from the Udaipur State Depot. Also WIF at Udaipur & Jodhpur
have been demanded by state.

GOI has not supplied
DFs & Spares (for non-CFC equipments) since last 3 years.should
be supplied this financial year

The main strategies for Immunization in RCH II are outlined below:
1. Initiatives for immunization in the state for Programme coordination
with partnersA State Level Steering Committee has been formed
which will finalize the annual action plan and review the same
on a monthly basis. Members will be Director (FW) as Chairperson,
Director (WCD) as Co-chairperson, Joint Director (RCH), DD Immunization
(member secretary), ICDS, Demographer, Statistical Officer, Representatives
of WHO, UNICEF,CARE and others.

A
State Task Force has been formed which will review the
immunization programme six monthly chaired by Principal Health
Secretary.A State Immunization cell has been formed which will
review the activities on a weekly basis.District Task forces have
been formed to review the Immunization activities in the districts.

2. Strengthening the State officials and RCHO through additional
mobility support

4.
Ensuring that all children in all villages/towns covered with
regular (monthly/quarterly) immunization sessions according to
village size through mobilization of children by ASHA for which
a sum of Rs.150 per month has been kept for mobilization of children
to the immunization session site. For Immunization in the Urban
area/slums provision of hiring ANMs for each session, and provision
of social mobilizers to mobilize the children to the session site

5.
Improved injection safety by introducing AD Syringes

6.
Ensuring accurate record keeping / monitoring with improved supervision
and Availability of various Formats

Two
days six monthly review meetings will be conducted at state for
district wise review of immunization programme.Monthly meetings
of State Steering committee will also be held. State task force
meeting will be organized to review the immunization status.Six
monthly meetings of State Task Force will be conducted under the
chairmanship of Principal Health Secretary to overall review the
situation of Routine Immunization in the stateZonal level review
meetings will be organized at seven zones of state to review the
immunization activities in the districts.

10.Contingency
fund at district levelRs. 40/ month per district has been budgeted
as contingency fund for communication cost (sending reports through
internet and for buying floppy disks) if needed from Districts
to State.

11.Disposal
of AD SyringesFor proper disposal of AD syringes after vaccination,
hub cutters will be provided to cut out the needles (hub) from
the syringes. Plastic syringes will be separated out and will
be treated as plastic waste. For the disposal of needles, pits
will be formed at PHCs as per CPCB guideline.

12.VPDSurveillanceSentinel
Surveillance Units: Hospitals and some other major Govt. and private
hospitals will be taken up for VPD surveillance:

Strengthening the
system already present in the state for VPD surveillance.

Orientation of the
medical officers of these units in standard-case definitions

A software to analyze
and present the data (RIMS)

Review of data
by JD RCH on a regular basis

The analyzed data
would also be fed back to the districts monthly, suggesting
follow-up action

Outbreak investigation
for which dissemination of guidelines and workshops to train
district officials (Rapid Action Team for epidemics) for investigating
outbreaks.

13.Hepatities B/Never
vaccine will be introduced

14.
IEC & Social Mobilization plans

Disease
Control Programmes

The
National Disease Control Programmes are being implemented in state
under NRHM with a view to achieve the MDG goals to halt the spread
of major diseases and reverse the trend by 2015 so as to reduce
the mortality and morbidity and increase life expectancy and quality
of life. The NDCP encompasses: Revised National TB Control Programme
(RNTCP), National Vector Borne Disease Control Programme (NVBDCP),
and National Programme for control of Blindness (NPCB), The National
Leprosy Eradication Programme (NLEP), Integrated Disease Surveillance
Programme (IDSP), and Iodine Deficiency Disorder Control Programme
(IDDCP).

The National Vector Borne Disease Control Programme (NVBDCP)

NVBDCP include major vector borne diseases of public Health importance,
such as Malaria, Filariasis, Japanese Encephalitis, Dengue, and
Kala azar. As per the National Health Policy 2002 the goal is
to reduce morbidity and mortality by 50% by 2010. In Rajasthan
only Malaria and Dengue are prevalent the strategy for control
of vector borne diseases includes:
· Enhanced Surveillance with support of community based
volunteers (ASHA) and grass root level workers.
· Early diagnosis and proper case management through strengthening
Primary and Secondary Health institutions.
· Integrated vector management using bio-friendly methods
and limiting use of insecticides.
· Epidemic preparedness and rapid response.
· Institutional strengthening and Capacity building of
Health personnel.
· Behavior change communication
· Intersectoral Collaboration
· Computerized Management information system.

The National Leprosy Eradication Programme

Leprosy is a disease of public health concern in India. It is
a disease of medico-social concern .Current prevalence is 1.8/10000.
Rajasthan has achieved prevalence elimination level (prevalence
below 1/10000) in 2000. Current prevalence Rate is 0.24/10000.
Under the NRHM the strategies drawn under the National Leprosy
Eradication Project to be continued. The fie component include
Decentralization and institutional development , strengthening
and integration of service delivery, disability care and prevention
, IEC and training. Services will be continued to be provided
at CHC, PHC, Additional PHC, and hospitals with support from the
district nucleus. The sub-centers will be involved in delivery
of second and subsequent doses of MDT. NGO will continue to be
involved in reconstructive surgery, disability care and prevention
and IEC. Village and district Health plans will enable identification
and ensure referral of cases requiring disability treatment to
the appropriate facility. CMHOs and medical officers will continue
to be trained on Leprosy Programme management.

Integrated Disease Surveillance Programme (IDSP)

Objective of IDSP is to establish a state based system of surveillance
through Information and communication technology (ICT) for communicable
and non-communicable diseases so that a timely and effective public
health action can be initiated in response to the health challenges.
IDSP will also improve the efficiency of the existing surveillance
activities of the different disease control Programs. Surveillance
system will be strengthened through Capacity building of medical
officers and health workers and technicians, strengthening of
laboratory network and reporting system through ICT. This would
p[provide a string foundation to the disease control Programmes
under NRHM. ASHA being the link between community and public health
system will strengthen the community based surveillance system.
Revised National Tuberculosis Control Programme (RNTCP)

The RNTCP is the vehicle through which through which the WHO recommended
DOTS (Directly Observed Therapy Short course) is implemented in
India. All the districts of Rajasthan are being covered. As part
of the Programme Designated Microscopy centers (DMCs) have been
established at PHC, CHC and district hospitals. RNTPC supports
the salary of laboratory technicians, laboratory supplies and
consumables. All medical officers are trained under RNTCP for
diagnosis management and referral. All SCs, PHCs, CHCs and district
hospitals function as DOTS centres. Community level DOTS providers
are also trained in delivery of drugs. Para medical staff is trained
in monitoring consumption of ant TB drugs. The RNTCP also involves
the civil society organizations in its outreach of communication
efforts. Under NRHM the ASHA will be the facilitator for early
access to the diagnosis, referral and follow-up as a community
DOTS provider.

National Blindness Control Programme (NPCB)

The National Blindness Control Programme aims at reducing prevalence
of blindness from the current level of 1.5% to 0.34% by the 2010.
Rajasthan state has set a target of about 3 lac cataract operations
every year to achieve the goal. Under NPCB apart from providing
surgical treatment through IOL (Intraocular lens) implant for
cataract, which is major cause of blindness, the other causes
of blindness such as childhood blindness, glaucoma and retinal
disorders are also dealt. School health check up is also one of
the major components of the Programme. ASHA would play an important
role in creating awareness of the Programme and motivate people
to seek treatment. NRHM would also seek to create synergy between
the NPCB and Vitamin A supplementation Programme.

Additional
Interventions under NRHM ASHA

Accredited
Social Health Activits

The
Government of India and Government of Rajasthan have launched
a National Rural Health Mission to address the health needs
of rural population, especially the vulnerable sections of the
society. The sub center is the most peripheral level of contact
with the community under the public health infrastructure. This
caters to the population norm of 3000 - 5000. The worker in
sub center is an ANM who is directly involved in all the health
issues of this population, which is spreaded over the wide area
of many kilometers and covering 5 to 8 villages. Many a times
the villages are not connected by public or private transport
system making her more difficult to achieve the objectives and
goals of providing quality health care for the poor and oppressed
sections of the society. So the new band of community based
functionaries, named as Accredited Social Health Activist (ASHA)
is proposed in the NRHM who will serve the population of 1000
and 500 in hilly and desert terrene.

ASHA
is the first port of call for any health related demands of deprived
sections of the population, especially women, children, old aged,
sick and disabled people. She is the link between the community
and the health care provider.

Department
of Medical and Health at State and at Center is looking at ASHA
as a change agent who will bring the reforms in improving the
health status of oppressed community of India. The investment
on ASHA will definitely result in to better health indicators
of state and at large the country.

ASHA Sahayogini

Convergence
of DWCD and NRHM
In each Anganwadi Center apart from Anganwadi Worker and Sahayoka
one additional worker named 'Sahyogini' is envisaged to provide
door to door information and services of Nutrition, Health, preschool
education. Her role is quite similar to the role of ASHA under
NRHM. So to avoid duplication of workers providing same types
of services in the same area, the decision was taken at State
level, that there will be only one worker coterminous with Anganwadi,
who will work with DWCD and DMHS. This worker is called as 'ASHA
Sahyogini', selected by the community through Gram Panchayat and
responsible to the community.

Criteria
for selection

One ASHA Sahyogini for each Anganwadi Center.

Woman resident of that area, Married/ Widow/ Divorcee

Age between 21 to 45 years

ASHA Sahyogini should have effective communication skills,
leadership qualities and be able to reach out to the community.

ASHA Sahyogini should be literate woman with formal education
up to eighth class, In tribal and desert areas the educational
qualification may be relaxed if the 8th pass candidate is
not available. This is permitted only after the approval of
State level Committee.

Adequate representation from disadvantaged population groups

Roles
and Responsibilities of ASHA Sahayogini

Create awareness

Health,
Nutrition, basic sanitation, hygienic practices, healthy living
and working conditions, information on existing health services
and need for timely utilization of health, nutrition and family
welfare services.

Facilitate to access and avail the health services available in
the public health system at Anganwadi Centers, Sub Center, PHC
, CHC and district hospitals.

Village
health plan

Work with the village Health and sanitation Committee to develop
the village health plan

Escorts/
Accompany

Escorts the needy patients to the institution for care and treatment.
She will accompany the woman in labor to the institution and promote
institutional delivery

Provision
of Primary Medical Health Care

Minor ailments such as fever, first aid for minor injuries, diarrhea.
A drug kit will be provided to ASHA

Provider for DOTS

Depot Holder ORS, IFA, DDK, chloroquine, oral pills and condoms

Care of new born and management of a range of common ailments

Inform Births, deaths and unusual health problem or disease
out break

Promote Construction of household toilets

Training

Capacity
building of ASHA is critical in enhancing her effectiveness. It
has been envisaged that training will help to equip her with necessary
knowledge and skills. Training of ASHA Sahyogini is a continuous
process. Considering her range of functions and task to be performed,
her induction training is planned for 23 days in 4 rounds (10+4+4+5
days). The trainings are planned in cascade model. The non governmental
organizations are involved in the training of ASHA Sahyoginis
at grass root level.

Compensation package (Incentives)

Under
NRHM ASHA Sahyogini is a voluntary worker who will get performance
linked incentives. The honorarium is linked with the performance
indicators of ASHA Sahyogini. The generic Compensation package
made for ASHA Sahyogini by linking her with different health programmes.

The
detailed compensation package is worked out at state level. If
she works as per the expected standards she would earn approximate
Rs. 1067 per month. ASHA will get the package on
Apart from the above package she may get prizes for extraordinary
performance in cash or kind from the untied funds. Some of the
selected ASHA Sahyoginis will visit different places in the State
and outside State during exposure visits.

Drug
Kit for ASHA Sahyogini - The drug Kit is provided to ASHA Sahyogini
to provide primary Health Care to the community like minor elements
like fever, pain, First Aid etc. The replenishment of medicines
is made from PHC /Subcenter stocks.

Monthly
Meetings - The joint monthly meetings are conducted at PHCs by
DWCD and DMHS. ASHA Sahyoginis are interacting with service providers
in this monthly meeting. The replenishment of Medicines and payment
of incentives are ensured during these meetings.

ASHA
Mentoring Group

For
strengthening ASHA- Sayogini Programme in the State a State Level
Mentoring Group is constituted under the Chairpersonship of Mission
Director, NRHM. This group will oversee the implementation of
the scheme and facilitate in developing the policy guidelines.
Mentoring Group will act as a think - tank for the programme.
The mentoring group will provide technical inputs and support
mechanism. The members of ASHA Mentoring Group are Director DWCD,
PHED, RD,PRI, IEC, RCH, PH, AIDs, representatives from development
partners and NGOs.

The
Mentoring Group will meet once in three months to review and to
provide inputs for the ASHA- Sahyogini Intervention. ASHA Resource
Center is the Nodal Agency to organize the meetings and do the
follow ups with the support of SPMU- NRHM.

ASHA
Resource Center for providing support to ASHA Programme at State
level

Need
for ASHA Resource Center - ASHA is at the base of NRHM pyramid
and National Rural Health Mission is looking at ASHA as a change
agent in Health Sector Reform. She will play a vital role in improving
the health indicators of the State especially IMR and MMR. She
will also facilitate the improvement in service off take of the
healthcare institutions.

The
State of Rajasthan is spread over a large geographic area with
religious, social, cultural, economic variations, so implementation
of ASHA component in the state is a challenging task. In this
context it is very important to provide technical inputs and strong
supportive mechanism to the programme so that expected results
can be achieved. State Project Management Unit is established
at state level under Director NRHM. SPMU is working as a technical
and administrative body to implement the activities of NRHM in
the State. ASHA Resource Center (ARC) is conceptualized to improve
the quality of the programme. This Center will be established
at state level and will work under direction of Mission Director
of NRHM

Functions
of the ASHA Resource Center-

Technical
backstopping in Training - The training of ASHAs is planned
for 23 days in a year with refresher trainings every year.
ARC will develop user friendly training methodology and the
training modules, print the modules in prescribed time, and
disseminate the modules in the District. The modules are being
developed by MOHFW; GOI .These will be modified in the state
context on the basis of functions of ASHA. ARC will also work
on the training modalities and will provide the supportive
supervision to maintain quality checks and control at District
and Block level.

Development of IEC material - ARC will be responsible for
developing or collecting the IEC material from different agencies
for dissemination during the training. The facilitation kit
including flip books, chart, posters etc on different related
issues will be developed and disseminated. Need based IEC
material will be developed from time to time.

Planning of Monthly Meetings - It is planned to conduct monthly
meeting of ASHAs at block level to resolve day -to -day functional
problems faced by ASHA and to ensure the progress of the activities
conducted by ASHA. It is very important to revise the concepts
and contents to improve the learning process .The topics covered
during the training will be revised in the monthly meeting.
ARC will develop tentative monthly agenda for the monthly
meetings; provide required resource material and IEC material.
It will develop the monitoring mechanism for the meetings.

Development of Reporting formats and registers - ASHA is envisaged
as a voluntary worker and to facilitate her work some very
easy and basic reporting formats and registers will be developed.
The registers and the formats will be used by ASHA only to
streamline her priorities. ARC will develop the formats and
will orient ASHA for its utility and use.

Processing of Statistical Data and records- On the basis of
reports and registers of ASHA and other sources of data’s.
ARC will compile the statistical data, analyze the data and
provide the feedback of the programme to the Mission.

Intersectoral Coordination pertaining to ASHA- ASHA is conceptualized
as a volunteer responsible for the Health needs of the particular
village, Dhani or Mohalla. The credibility of ASHA in the
community could be used by other Development Departments to
promote their objectives. ARC will coordinate with different
departments and facilitate empanelment of ASHAs in various
other programmes like Sarva Shiksha Abhiyan, Total Sanitation
Programme etc.

Involving NGOs to strengthen the programme- Involvement of
NGOs is an important task in the implementation of ASHA programme.
NGOs could support the ASHA to work at community level or
to develop capacities of ASHA etc. There could be many roles
of NGOs and these roles would be identified by the ARC. In
consultation of NRHM the NGOs should be involved in the programme.

Provision of Drug Kits- ASHA will provide the basic medical
care to the community. The drug kit with basic medicines and
supplies will be provided to all the ASHAs under NRHM. The
drug Kit will consist of allopathic as well as Ayush medicines.
ASHA will charge the user fees from the community. Initially
the drug Kits are being provided by GOI. They may need state
level modification / supplementation. In such case ARC will
facilitate the procurement process and supply it to ASHA.
This is not one time activity and regular stocks should be
available with ASHA. ARC will develop the mechanism to maintain
at least two months stock of medicines with ASHA.

ASHA Sahyoginis role in Village Health Plan - NRHM is promoting
the down - up approach for implementation of different health
programmes. It is proposed to form Village Health Societies
and Village Health Teams to address the health needs of the
Village. ASHA Sahyogini will be one of the important members
of VHC and VHT. ARC will be responsible for capacity building
of ASHA Sahyogini so that she could help in planning and implementation
of Health Programmes in the Village.

Organize Quarterly meeting of Mentoring Group - A Mentoring
Group is constituted to provide overall guidance to the programme
and act as a think - tank for the programme. The mentoring
group will provide technical inputs and support mechanism.
ASHA Resource Center will conduct the quarterly meetings of
the mentoring group and incorporate the valuable inputs provided
by the group in the programme.

Provision of services of Helpline - ASHA Sahyogini in near
future will work in entire state. There will be more than
45,000 ASHA Sahyoginis in the State. Time to time trainings
or monthly meetings may not suffice the need of the ASHA Sahyogini.
So the ARC will form the helpline for the ASHA Sahyogini and
associated functionaries. ARC will respond to the queries
or clarifications needed in the field. ARC will ensure that
the prompt help is provided to ASHA.

Organizing ASHA Sammelan, Exposure visits- There will be Sammelans
at State level, Zonal level and District level to share the
experiences of ASHA Sahyogini and for cross learning’s.
ARC will organize such events with the help of State Health
Society and District Health Society. ARC will also organize
the exposure visits with in the state and outside the state.

Other issues related to the functioning of ASHA - Some of
the functions of ARC is mentioned above. The role of ARC is
multifaceted and visualized in broader sense. The functions
of ARC could be revised as per the need and requirement of
the programme. Some new roles could also be incorporated.

Linkages of ASHA Resource Center- ASHA Resource Center is
a Hub for ASHA Component under NRHM, which will work in close
association with Mission Director. The administrative control
on the ARC will be of the outsourced agency, but the Mission
Director will be involved in major decisions like recruitment
of professionals, budget etc. However day to day functioning
will be the responsibility of outsourced agency. ARC will
provide support to the districts through NRHM and all the
administrative guidelines will be issued through NRHM.

A Nodal officer has been appointed in each district to implement
this scheme effectively.

Untied
Funds

There
was an urgent need to strengthen the Subcentres and to also decentralize
its functioning to improve the quality of services and make it
community friendly. For the first time in the history of the FW
programme it was proposed to provide untied funds.

As part of the National
Rural Health Mission, it is proposed to provide each sub center
with Rs.10,000 as an untied fund to facilitate meeting urgent
yet discrete activities that need relatively small sums of money

The fund shall
be kept in a joint bank account of the ANM and the Sarpanch.

Decisions on activities
for which the funds are to be spent will be approved by the
Village Health Committee (VHC) and be administered by the ANM.
In areas where the sub center is not co-terminus with the Gram
Panchayat (GP) and the sub center covers more than one GP, the
VHC of the Gram Panchayat where the SC is located will approve
the Action Plan. The funds can be used for any of the villages,
which are covered by the sub center.

Untied Funds will
be used only for the common good and not for individual needs,
except in the case of referral and transport in emergency situations.

Suggested areas
where Untied Funds may be used include:

Minor modifications
to sub center- curtains to ensure privacy, repair of taps, installation
of bulbs, other minor repairs, which can be done at the local
level

Purchase of bleaching
powder and disinfectants for use in common areas of the village.

Labour and supplies
for environmental sanitation, such as clearing or larvicidal
measures for stagnant water.

Payment/reward
to ASHA for certain identified activities.

6. Untied funds shall
not be used for any salaries, vehicle purchase, and recurring
expenditures or to meet the expenses of the Gram Panchayat.

IPHS

Under
National Rural Health Mission Strengthening of CHCs as per the
norms of Indian Public Health Standards (IPHS) is an important
component. Under this component all the CHCs of the State will
be up graded in phases. Under this component 64 CHCs have been
selected for up gradation in the year 2005-6. In the year 2006-07
64 more CHCs has been seleceted for up gradation. Now total number
of CHCs selected for upgradation to IPHS is 325.

Selection
of 64 CHCs has been done after avoiding duplicity
with other programme specially the RHSDP. For the year 2006-2007,
64 institutions will be selected. It is proposed that the
institution selected by RHSDP will be selected under NRHM
and support for construction of quarters will be undertake
in this year as under RHSDP there is not any provision for
construction of staff quarters. It is expected that by providing
support of construction of staff quarters all the 64 CHCs
being strengthening under RHSDP will be functional fully with
in a year as other facilities and support is being done under
RHSDP in these institutions.

Facility
survey of the 64 CHCs of first phase has been completed.
Data regarding man power position, at CHCs, requirement of
equipments, furniture, drugs and supplies collected through
the facility survey. The facility survey regarding the civil
works is being done by RHSDP. For the institutions of phase
–II facility survey will be done by NRHM. Facility survey
for civil works has already been done by RHSDP.

Procurement
of equipment and furniture- Requirement of CHCs for
the first phase has been obtained through Facility survey.
As per decision process of procurement has been initiated.
So far purchase orders of the 21 items with cost of Rs.18810078.00
have been placed. Procurement rest items under process. The
supplies of equipment and furniture for the CHCs of II phase
will is being ensured by RHSDP.

Manpower
status - Manpower status of CHCs for the phase -I
prepared and request has been send to Director, PH for posting
of required staff on vacant positions and also facilitate
the process for creating new posts on CHCs as per IPHS norms.
For the CHCs of second phase same pattern will be obtained.

Civil
Works - The process of hiring the consultant agencies
for supporting operationalization of civil/repair and renovation
work under NRHM at CHCs to upgrade as per IPHS norms was initiated
and two agencies AVL and PWD selected to provide support in
civil works under NRHM as per IPHS.

Building plan for the quarters has been approved. Actual construction
work is started. RHSDP will work on 193 CHCs and PWD will work
on 132 CHCs.

Health
Facilities

Strengthening
of Public Institutions for health Delivery

The Rural Health Care System forms
an integral part of the National Health Care System. Provision
of Primary Health Care is the foundation of the rural health care
system. For developing vast public health infrastructure and human
resources of the country, accelerating the socio-economic development
and attaining improved quality of life, the Primary health care
is accepted as one of the main instrument of action. Primary health
care is the essential health care made universally available and
accessible to individuals and acceptable to them through their
full participation and at a cost the community and the country
can afford.

Although vast network of this
infrastructure looks impressive, accessibility, availability of
manpower and quality of services, and their utilization have been
major issues in the Public health care delivery system. Adequacy
of coverage is an important issue. The number of facilities is
not adequate when we consider the current population.

The primary Health Care structure in the country
has been established as
per the following norms:
Centre Population Norms
Facility Plain areas Hilly/Tribal areas
Sub-centre 5000 3000
Primary Health Centre 30,000 20,000
Community Health Centre 1, 20,000 80,000

Sub-Centre
Sub Centre is the first peripheral contact point between community
and health care delivery system. A Sub Centre is manned by one
Female Health Worker (ANM) and one Male Health Worker (MPW). One
Lady Health Visitor (LHV) for six sub-centres is provided for
supervision at the PHC level.

Primary
Health Centre (PHC)
PHC is the first contact point between village community and the
Medical Officer. Manned by a Medical Officer and 14 other staff,
it acts as a referral unit for 6 Sub-Centres and has 4-6 beds
for patients. It performs curative, preventive, promotive and
family welfare services. These are established and maintained
by the State Governments. Currently there are 23109 Primary Health
Centres in the country.

Community
Health Centres (CHCs)
CHCs are established and maintained by the State Governments.
Manned by four specialists i.e. Surgeon, Physician, Gynecologist
and pediatrician and supported by 21 paramedical and other staff,
a CHC has 30 indoor beds with one OT, X ray facility, a labour
room and laboratory facility. It serves as a referral centre for
4 PHCs. Currently there are 3222 Community Health Centres in the
country.

Activities
to be taken up for strengthening the facilies:

I.
Strengthening of the Physical Infrastructure of the existing facilities:

New Facilities: New centres need to be established in order
to cover the entire population of the country as has been
discussed before.

II.
Manpower

The vacancies need to be filled up. In Rajasthan a decentralized
mechanism exists for the appointment of Contractual appointments
of MO. ANM, Lab Technician.

III
Equipments, Drugs and other supplies:

A list of essential drugs, equipments and other supplies have
been prepared by GOI. An Essential Drug list exists for Rajasthan.
Streamlining of the Logistics and Warehousing systems needs tro
be done for timely supply of quality drugs

IV.
Training

NRHM envisages an accountable system for delivery of quality services.
For quality services, the skill of the health personnel needs
to be improved. The attitudinal changes in the health personnel
to be responsive to the health needs of the community will require
orientation of health personnel. In this context, the induction
training, in-service skill development training, and management
training of the health personnel are being planned in.

RCH-Phase-II. The training load of various categories
for personnel is as follows:

Rajasthan is the state with second
highest mother in maternal mortality in India. Approximately total
number of deaths of pregnant ladies in Rajasthan in one year is
equivalent to total number of deaths of pregnant mothers in five
years in Kerala.
World over it has been observed that delays at three levels are
the reasons for the deaths of the pregnant mothers. Most of the
deaths of pregnant mothers can be averted by addressing these
delays.

First
delay: - Occurs at house hold levels in taking decision
to seek medical help and there is no preparedness for delivery
of the baby.

Second delay: - Occurs during the transportation
of the pregnant lady to the appropriate place. Many a times
either vehicle is not available or the money is not available
to hire the vehicle. There is lack of knowledge regarding
the right place where the pregnant lady should be transported
in case of emergencies

Third
delay: - Occurs at the facility level, when a pregnant
lady reaches at facility either trained manpower, equipments
or drugs are not available. Hence initiation of treatment
is delayed .To address all these delays and problems faced
by a pregnant lady, in the state has been studied and a multi
pronged strategy has been developed .The following activities
are planned and are being implemented by the Government of
Rajasthan for reducing maternal mortality in the state.

(1)
Training of field staff, posted in remote & far flung
areas in
(2) Strengthening of referral transport.
(3) Awareness generation in the communities for preparedness
of delivery of the baby.
(4) Strengthening of facilities to provide comprehensive and
basic emergency obstetric care services round the clock through
out the year.

CEmOC
is a center to cater the needs of population of around five lakhs
and should provide all the above six services along with the following
services round the clock through out the year.

1. Availability of blood and blood transfusion facility.
2. Facility for Caesarian section for delivery of foetus in
emergency cases.

As per the UN process indicators a total number of 128 CEmOCs and
459 BEmOC are required to provide emergency obstetric care services
to all the pregnant ladies, of the state.

In the regard a total number of
187 institutions have been identified to provide comprehensive
emergency obstetric care services in the state keeping in view
the geographical conditions and population of the state. These
institutions will be strengthened in a phased manner, in the first
phase 137 institutions will be strengthened and remaining 50 institutions
will be strengthened in the second phase.

Similarly a total of 173 institutions
are identified to provide basic emergency obstetric care services
by the end of this year.